Healthcare Provider Details

I. General information

NPI: 1639837917
Provider Name (Legal Business Name): KIDOLOGY PEDIATRICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2021
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4967 CROOKS RD STE 250
TROY MI
48098-5809
US

IV. Provider business mailing address

4967 CROOKS RD STE 250
TROY MI
48098-5809
US

V. Phone/Fax

Practice location:
  • Phone: 248-654-6499
  • Fax:
Mailing address:
  • Phone: 248-654-6499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NEETHI R PATEL
Title or Position: OWNER/PHYSICIAN
Credential: DO
Phone: 248-654-6499